Intranasal influenza vaccination is well-tolerated in egg allergic children with asthma or recurrent wheeze.
Nobody likes getting a shot, especially children. However, US health guidelines recommend annual influenza vaccination of children, especially those with asthma, and including those with egg allergy. Live attenuated influenza vaccine (LAIV) is an intranasal vaccine administered via the nose licensed for use in children. However, this vaccine contains egg protein and it is currently suggested that it not be used on children with egg allergy. Furthermore, North American guidelines recommend against its use in children with asthma. Thus, asthmatic or egg allergic children receive a traditional flu shot.
In a study recently published online by The Journal of Allergy and Clinical Immunology (JACI), Turner and colleagues present the results of the SNIFFLE-1 Study. In this study, 433 doses of LAIV intranasal flu vaccine were administered to 282 children with egg allergy. Two thirds of the children also had a physician diagnosis of asthma/recurrent wheezing and 41% had experienced a prior anaphylactic (severe allergic) reaction to egg.
The study found that influenza vaccination using LAIV was safe in egg-allergic children – including those with a prior history of anaphylaxis – with no systemic allergic manifestations seen. Eight children experienced mild short lived symptoms, which may have been due to an IgE-mediated allergic reaction. However, noting the intranasal reaction thresholds to egg, the authors suggest these reactions were not likely to have been caused by egg protein and were probably due to other ingredients in the vaccine.
Importantly, in those children with a history of asthma or recurrent wheezing, there was no significant increase in respiratory symptoms requiring medical treatment in the 72 hours following vaccination with LAIV. This suggests that the current guidelines may be unnecessarily over-restrictive in terms of this vaccine’s use in patients with asthma or egg-allergy. This study may help lead to changes in the current guidelines and make an annual flu vaccine more pleasant for kids with asthma and egg allergy.